Provider Demographics
NPI:1376706127
Name:BOLLE, JEANNE (MS, LLP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:BOLLE
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1228
Mailing Address - Country:US
Mailing Address - Phone:616-866-4830
Mailing Address - Fax:
Practice Address - Street 1:16 N MONROE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1228
Practice Address - Country:US
Practice Address - Phone:616-866-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008183103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical